In a conventional polyp removal operation, an endoscope is inserted into an internal cavity of a patient, e.g., into the colon, and is used to locate abnormal tissue growths such as precancerous polyps or cancers in the internal cavity. Upon locating a polyp, or another growth, which is to be removed, a surgeon or gastroenterologist extends a wire through a tube in the working channel of the endoscope and slides the wire in the distal direction so that a cauterization loop connected to the wire is ejected from the distal end of the tube and the endoscope. The loop and the endoscope are manipulated from outside of the patient to pass the loop over the polyp or growth. The wire is then withdrawn in the proximal direction to position the loop around the neck, or pedicle, of the polyp or growth. Once the loop is in contact with the neck of the polyp, electrical current is conducted through the loop via the wire. Generally, as the loop is closed over the base of the polyp, electrical current is transmitted through the narrowed organic tissue and thereby generates therein heat sufficiently great to cut and cauterize the polyp, ressecting it off the colon wall.
The above-described procedure is not difficult when the polyp has a neck, or a pedicle. However, if the polyp is flat or sessile, it is very difficult to grasp and surround it with the snare for adequate transection. Often the snare slides off the polyp, and in many cases the polyp has to be removed in a piecemeal fashion because the entire lesion cannot be snared at once. In addition, sessile polyp resection presents the danger of organ perforation. The wall of the colon is very thin. If successive burning takes place, the cautery current may burn through the wall of the colon, causing a perforation. This complication is life-threatening and requires immediate surgical intervention. This problem has been partially but inadequately addressed by injecting saline into an area or areas adjacent to the flat lesion. During this process, several injections are administered around the flat lesion. The injections are delivered through a very short stainless steel needle, the length of which is limited by the curves of the fiber optic instrument. This short needle is oftentimes insufficient to deliver the necessary amount of fluid. More often than not, the area surrounding the flat polyp is raised, essentially burying the polyp even deeper in the middle of the mounds of saline that are created. In the best-case scenario, the flat polyp ends up on top of a single large mound. This mound is smooth, slippery, and despite the fact that it is larger than the original lesion, it is still too flat to snare. The lesion to be removed does not have a narrow neck or pedicle to enable snaring, but does in fact have a base much broader than its body.
In another kind of surgical procedure, pertaining to internal bleeding, the patient has to be rushed to the operating room for resection of the part of the organ that is bleeding. More often than not the bleeding occurs through an artery, wherein the blood is pumped out rapidly, threatening imminent exsanguination and patient death. Attempts have been made to control such bleeding through use of the fiber optic endoscope. These attempts have been inadequate at best. One of the methods used to control such bleeding is injecting saline solution, or a mixture of saline and epinephrine (a vasoconstricting agent), around the bleeding site. The site is first washed off with water administered through a catheter introduced through the working channel of the endoscope. This catheter has then to be removed, and the mixture of water and blood is suctioned through the suction channel. A sheath housing a singular needle is then introduced, and an injection is made near the bleeding source. The endoscopist attempts to inject all around the bleeding source causing a mound or mounds to be raised around the bleeding vessel. This process takes a long time during which the patient continues to bleed. Saline and saline with epinephrine stay concentrated in one location in the tissue for two to three minutes, and then re-absorption into the systemic circulation occurs. This is not enough time to form an adequate clot and arrest the bleeding.
Another kind of procedure addressed herein pertains to gastro-esophageal reflux disease (GERD). This common problem affects one third of the population in the United States. Acid reflux is caused by a lax gastro-esophageal sphincter. The sphincter between the esophagus and the stomach is the natural barrier to acid refluxing up from the stomach into the esophagus. When this barrier malfunctions, acid freely splashes up and into the esophagus causing heartburn, esophageal inflammation, ulcerations, Barrett's Esophagus, esophageal cancer, and respiratory problems. Presently, GERD is treated with medications, which shut off acid production in the stomach. Most patients need to take this medication for a lifetime. Recently, a number of methods have been attempted to correct this problem through the fiber optic endoscope. An endoscopic sewing machine has been invented, with which pleats are created beneath the lax gastro-esophageal sphincter. This instrument is costly and difficult to use, has resulted in esophageal tearing and perforation, and has not been proven to cure GERD.
This disclosure also relates to the method of injecting anesthetics or other medications around a lesion on the body surface. When a patient comes to the emergency room to be treated for a laceration or a cut, before sewing this cut closed, a local anesthesia must be administered. This process is lengthy and painful: a series of singular injections into and along the wound site are administered, causing ostensibly similar discomfort than would occur with suturing the wound without the anesthetic. The same problem exists during resection of a local breast mass, lypoma, or other superficial lesions.
This disclosure also relates to the problem of injecting a tumor mass with a chemotherapeutic agent. If a single needle is used, numerous injections at different locations and depths of the tumor must be administered. This is traumatic, erratic, and frequently does not achieve the desired effect.
This invention also relates to the problem of having to insert a needle or another slim surgical instrument through the narrow biopsy channel of a fiber optic endoscope or laparoscope. The configurations that the endoscope must be capable of assuming necessarily imposes limitations on the shape of the surgical instrument.